MedCity Influencers, Telemedicine

Why geriatric care must evolve post-Covid-19

Even relatively healthy older adults see the benefit of receiving home-based primary care, not just because of its convenience, but because patients feel safer at home now, and more unsafe than ever in ambulatory settings surrounded by other sick patients. 

Medical doctor applying medicine inhalation treatment on senior woman by the mask of inhaler during coronavirus quarantine

It would be hard to overstate the impact Covid-19 has had on every part of the healthcare industry. From primary care doctors to heart surgeons, retail clinics and academic medical centers, every organization in the business of treating patients continues to face uncharted territory through this once-in-a-century pandemic.

There are unique lessons to be learned about how the pandemic has impacted geriatric patients. Social distancing has illustrated important gaps in care, and the solutions developed in response to the pandemic can extend beyond the current public health crisis to improve geriatric care in the decades to come.

While the industry faces a continued uptick in cases and also considers what a post-Covid-19 world might look like, here are a few insights we found when it comes to evolving geriatric care.

Telemedicine isn’t a definitive solution to care gaps
When the healthcare industry looks back, Covid-19 will mark a turning point for telemedicine. For years, patients and providers alike have been slow to adopt this evolution in care delivery, but due to social distancing, patient needs changed nearly overnight, and usage spiked.

Telehealth companies are reporting substantial growth due to the pandemic, and a recent report predicts a seven-fold spike in telemedicine growth by 2025. However, it is important to note that while telemedicine is a fantastic tool for so many kinds of healthcare services, it has limited use for geriatric patients.

For instance, 30 percent of our patients have either moderate or severe hearing loss; 20% are vision-impaired and 25% have dementia. Our average patient is 79 years old – in other words, they were already eligible for Medicare when Steve Jobs announced the first iPhone in 2007. Fewer than half of our patients have a smartphone and are comfortable using one.

This means telemedicine simply doesn’t work for large swathes of our patient population – but they still need a solution for accessing care when they can’t access a healthcare facility, whether that’s due to Covid-19, frailty, lack of transportation, or any other reason.

As payors and providers look toward adopting and implementing technology and other care delivery reforms in advance of future outbreaks or post-pandemic, the industry must be sure to also consider how to provide care services to those for whom virtual visits aren’t an option.

In-home care must be fully comprehensive
Different kinds of care can be provided in the home, but often, patients and providers alike tend to think narrowly. There is a perception that the model is built exclusively around routine care and case management, or post-discharge, home-based care.

These are important services. But the pandemic has shown that the in-home model can be used for so much more. But to ensure patients are taken care of during Covid-19 and beyond, in-home care must be comprehensive.

This necessarily means focusing on urgent care and behavioral care. Geriatric patients often manage multiple chronic conditions and often result in urgent needs. Even while emergency visits dropped 42% according to the Center for Infectious Disease Research and Policy, acute and urgent needs didn’t stop.  So providers caring for a senior population with complex needs must find a way to keep urgent care as core to their care model.

Behavioral health is another essential piece of comprehensive care during the pandemic. The World Health Organization reports 20 percent of older adults suffer from a mental or neurological disorder, which is often under-identified by healthcare professionals – nearly 60 percent of these patients go without treatment. Already often socially isolated, Covid-19 has caused unprecedented levels of fear, anxiety and depression in the senior population and further illustrates the need for more robust mental healthcare services in geriatric care. With it still being largely unsafe for the vulnerable to receive care outside the home, and virtual care as a limited option, the industry must establish models of care that bring these needed services to patients directly.

The pandemic will have a lasting impact on where geriatric care is delivered
Historically, in-home care has been limited – in scale, geography, and services. The need for in-home care delivery continues to grow though many still do not have access to primary care in the home.

But the pandemic has forever altered our understanding of what can be done in the home, just like its reframed our understanding of “essential worker.” We find that even relatively healthier older adults see the benefit and are interested in receiving home-based primary care, not just because of its convenience, but because patients feel safer at home now, and more unsafe than ever in ambulatory settings surrounded by other sick patients.

Increasingly, patients are going to expect a home-based option for care, especially as we prepare for a second wave of the virus later this year. Geriatric care is a complex specialty – and Covid-19 has added additional complexity, but the Centers for Medicare and Medicaid Services and Medicare Advantage plans can take steps today to ensure more patients have access to in-home care options throughout this year and beyond.

Photo: filadendron, Getty Images

Nick is the Chief Executive Officer (CEO) of Landmark Health. With over 30 years of experience, Nick joins Landmark from McKesson where he most recently served as President of McKesson’s U.S. Pharma and Specialty Health businesses. In this role, he was responsible for overseeing business development, sales, distribution, and operations across all markets.

Prior to that, Nick was President of McKesson Canada from 2011 to 2014 and Vice President and General Manager of McKesson from 2003 to 2011. Before joining McKesson Canada, Nick was Managing Partner with Ascend LLC, a business development and management consultancy which he founded. He has also worked in progressively responsible management and executive roles in a variety of sectors, notably in telecommunications and manufacturing.

Outside of work, Nick enjoys spending time with his wife, two adult children, cooking, cycling and skiing. He has been a member of various healthcare boards and foundations and participates in community health events. Nick received his Bachelor of Science in Mechanical Engineering from McGill University in Montreal, Quebec.

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